Lateral Ankle Sprains | Plenty Physiotherapy, Bundoora

Lateral Ankle Sprains Document 

A lateral ankle sprain involves  damage to one or more of thelateral ligaments of the ankle, most commonly the: • Anterior talofibular ligament  (ATFL) – most frequently  injured • Calcaneofibular ligament  (CFL)• Posterior talofibular  ligament (PTFL) – least  commonly injured he injury typically results from forced inversion and plantarflexion (inwards ankle  rolling), often during sport, running, changing directions, or uneven surfaces. This can  lead to the stretching, tearing or rupturing of the ligaments on the outside of the ankle,  as discussed above.  There can be a ‘grade’ assigned to the injury related to the severity of injury to the  ligaments. Lateral ankle sprains are often graded 1-3. 1) Grade 1 (Mild): Slight stretching and microscopic tearing of the ligament fibres,  commonly the anterior talofibular ligament. Mild tenderness and swelling  around the ankle with minimal ankle joint instability.  2) Grade 2 (Moderate): Partial tearing of anterior talofibular ligament and some  tearing of the calcaneofibular ligament. Moderate tenderness and swelling  around the ankle and can have some ankle joint instability. Often these  individuals will have difficulty with weight-bearing and ambulation-based  activities.  3) Grade 3 (Severe): Complete tear of the anterior talofibular ligament, the  calcaneofibular, and the posterior talofibular ligament. Significant tenderness  and swelling around the ankle. Joint instability is a presenting factor. Individuals  will have large difficulty or even inability with weight-bearing and ambulation based activities. Treatment/Management: Acute management:1) POLICE method principals: Protect: Bracing/Moonboot or taping.OL (Optimal Loading): Weight-bearing as tolerated/Nil weight-bearing +- Crutches/gait aids. Ice: 15–20 min every 2–3 hours. Compression: Tubigrip or compression bandages to manage swelling and pain. Elevation: Ankle above heart height for swelling management.   Imaging/referrals: Starting with lower dosed over-the-counter non-steroidal  anti-inflammatories (NSAIDs), can help with the pain and excessive  inflammatory components that are associated with these sprains. Stronger types  can be recommended and prescribed as per your GP/Doctor. Over-the counter  pain killers can also be used to manage pain as required (as per medical team  recommendations). Imaging referrals may be recommended in certain cases to  see the extent of the ligamentous damage and/or to rule out any other sinister differentials such as fractures. Rehabilitation/ Sub-acute management🡪 1) Early tolerated mobility and strengthening:  - As tolerated gentle ankle motion movements  - Foundational ankle banded strengthening exercises as tolerated for the ankle  and lower limb. - Overtime there will be a tailored rehab program integrated to target your  specific sport/activity movements demands, whether it be by increasing the  weight, intensity, or agility/plyometric loads, you will progress  appropriately.  - Low impact as tolerated cardiovascular exercise  2) Manual therapy: Soft tissue work and dry needling in the tissue surrounding the  ankle joint to help with pain, normalised joint movement, swelling, tightness and  encouraging early healing. Joint mobilisations in the more sub-acute phase may  be utilised if the ankle joint becomes comparatively more stiff.  3) Balance/proprioception: Working on specific deficits such as balance and  proprioception. This is important as proprioceptive nerve endings in these  tissues can be hurt and injured too. These proprioceptive nerve fibres help us  understand where our ankle is in space/awareness of the ankles positioning  when moving. It is important to work on this due to these reasons to help  minimise reoccurrence of ankle sprains. 4) Gradual return to activity/sport: Everyone will have different severities of injury and progress and different rates. Each will also have different goals and  demands they need to reach. Due to this, your physiotherapist will guide you in a  safe and tolerated manner to get back to your daily life or sport.  5) Medical: In some scenarios, a referral to an orthopaedic surgeon may be  necessary if the injury is severe and involves multiple structures. It may also be a  valid option if the individual is not progressing as expected with their  conservative protocols. Your options will be discussed with your physiotherapist  specifically.